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[Administrivia note: I wrote this at the end of December, but am only now posting it. I kept thinking I was going to find something better and replace or revise this, but I haven't. If you know of a resource with better advice on this topic, please share!]

Has your friend, family member or coworker recently announced that they spent some time in an inpatient mental health facility? Have they explained recent changes in demeanor or behavior as being the result of a "meds adjustment"? Have they had to take time off, because of a mental health crisis? It can be very difficult to know how to respond to these announcements. Depending on your relationship to the person making the announcement, we might have very strong feelings of our own about that person's recent demeanor and actions. We might feel a much stronger sense of connection to them as a result of this announcement -- and that stronger sense of connection might or might not be wanted.

If you can find some advice in a book or online about how to respond to this sort of announcement, please tell me! I've done a little looking around and found many interesting things but, alas, nothing apropos. Here are some suggestions.

First, consider as quickly as you can the time and place. The person making the announcement may have had to really work hard to get to the point of telling you or anyone else. They may have picked a really unfortunate time and place for the announcement, and they may have trouble limiting the details conveyed to ones that are appropriate to the time and place. Help them out with this. "What you are telling me sounds like very sensitive information that is not appropriate to this time and place." If you are very clever, and have an alternative location and some time to devote to this conversation, "Let's step into this office, where we can talk for 20 minutes." Don't offer to talk as long as they need to talk. That might make it even harder for them to sustain focus and result in them exhausting themselves.

Second, validate that it was probably not easy for them to tell you what they are telling you. "I recognize that this information can be extremely difficult to share."

Third, clearly convey that you actually heard what they said. Repeat back the salient portion in as close to their words as possible. "I hear that you recently spent time in an inpatient facility/had a meds adjustment/experienced a mental health crisis/are newly diagnosed with X personality disorder, etc."

Fourth, convey YOUR response. If a friend that you had been hoping would share finally has, "I appreciate your trust and willingness to share this with me." If a coworker, "Thank you for taking the time and effort to share this information with me." If you really don't want any more like this, "Please know that there is no need on my side for you to share any more details with me." If they are really not stopping, you can escalate to holding your hands up in a stop gesture and say, "I am very uncomfortable with this conversation and I am going to step away from it now." Hints may not work, and attempts to use social pressure and similar techniques to stop the flow are more likely to be misinterpreted than this very bald statement. If you do this, don't soften it by promising to come back to it later, while hoping they don't. Offering hope in this situation is not kind to them, but only cruel.

Fifth, affirm the nature of the relationship that you want going forward. "I love you dearly, and this really helps me to better understand you." "Being able to work with you is important to me, and having this information will make it easier for me to coordinate with you." "I will continue to treat you with the respect and professionalism that I treat everyone here at [location]." While it might be difficult, now is not the time for comments along the line of, "Well, that sure explains a lot." It might be hard, but save that for a private, confidential conversation with someone from your own support network. Everyone will be much happier if you save any remarks about how you relate the announcement to the person's recent behavior or demeanor until after you have had some time to think about it.

Wrap it up in a sincere appreciation for the effort they put into it: "Again, I know that talking about this is often very difficult, and I appreciate that you are trying so hard to make sure I understand."

If you want to offer support and assistance, make it clear that you are asking for them to clearly _ask_ for what they need -- you are not going to guess, and while it can be an unconditional offer to listen to specific requests, it should NOT be an unconditional offer to do anything that is requested. "Please let me know if there is something specific I can do to support or assist you with this. I will do what I can."

If you frequently use a generic well-wishing statement, and have used it before with this person, such as "My thoughts are with you" or "I will pray for you" or something similar, feel free to tack that onto the end. But if you've never used such language before, now is not the time to start. If your history with this person includes physical touch -- handshakes, backslaps, social hugging -- and you feel so inclined, that is okay as long as you don't override any resistance on the part of the person making the disclosure. Be sensitive to non-verbal hesitation, in particular. This is NOT the time to offer physical comfort to someone who you have never touched before.
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Hard to believe that it is time for A's 3 year re-eval. Apparently other people lost track of time, too, so forms came out a little late. I am unconcerned; it'll get done, and there will be more of the same and progress will continue.

I got some housecleaning done; things are finally shaping up a bit. Between the holidays, travel and being sick and other distractions, I got behind.

Minor trigger warning for some of my readers: this next bit is about family.

I woke up this morning with a weird realization. I was raised in a family and a religious organization with a very rigid set of ideas about family structure. And I don't just mean one-man-one-woman-no-divorce, either. I mean, man is head of household, woman obeys, etc. And in case it wasn't completely obvious, there is never, ever, ever supposed to be any difference of opinion between the 'rents. I absolutely don't agree with any element of this (why exactly two 'rents, why of opposite genders, why no differences of opinion, etc.). What I realized this morning is that children who are raised by otherwise loving caregivers who have important differences in values _and who place those differences front and center in their own relationship_, thus influencing the children to take sides, kids can get stuck in an awful insecure attachment loop with parents who otherwise probably would provide secure attachment structures. Because of the yo-yoing between I'm on this one's side, no I'm on that one's side.

Differences of opinion can be profound, but as long as they are not perceived by the kiddos as a side-taking sort of situation, I don't think the effect is particularly bad. The problem is the impact on attachment.
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My sister and I travel together a couple times a year (with our respective families). Her style of packing is very different from mine. Neither one of us is really a pack-heavy sort of person, but she's basically got things down to, aw, heck, I'll just do laundry every day anyway, so why bother to bring more than 2 changes of clothes anyway? Which is sort of amazing, but completely reasonable.

After visiting her in DC (driving trip, not a flight, at least this time), I got to thinking about my packing strategies (this always happens when I travel). I'd been keeping a packed, under seat (nominally) roller with all the non-clothing stuff (spare glasses, OTC meds, toiletries, charging setup, laundry pellets, etc.) read to go for a few years, but I didn't do the same thing for a bag of clothing. I had an odd night on the trip and woke up thinking, hey, I know how to do that now. I figured I'd forget it by the end of the day, or by the time I got around to being able to implement, but nope. I got home, I got settled in, and I promptly packed up a bag with clothes. It was weird. I'd been trying to figure out how to do this on and off for a while, ideally in a carry-on form factor and all of a sudden it just came together. I didn't even buy anything for the project (altho inevitably, the project spawned other thoughts so shopping happened anyway. I have the cutest 250 ml cocktail shaker now).

Mostly, the success of this endeavor confused me. Why hadn't I done this sooner? I had bought an Osprey Porter and Daylite and everything went in beautifully. So I could have been backpacking for how many trips? And I wasn't? Why wasn't I? What Had I Been Thinking?

After pestering my friends with this tale, R. and I worked out the details while having lunch at Raven last Friday (dear goddess, I hope I haven't already posted this story once -- my brain is wonky at times). Late summer 2014, we went to the World for a very short trip, carry-on only. I bought the Osprey bags but did not use them on that trip. Why didn't I use them? Because A. was still needing a stroller sometimes. I rented strollers in the parks up until April of _this year_, and I still would carry her on the Zuca bag as recently as a couple years ago. No point in going backpack if you are stuck rolling a kid. It's just miserable, especially without a stroller to stack the bags on.

Also, backpacks really didn't work for me -- not substantial ones, anyway, day bags were generally okay -- for several years after A. was born. The details are none of your business, and I don't say that often.

So. I was using rollers because I toted a kid on one of the rollers part of the time. And I was backpack averse because of some ... issues. Now that A. can get through a whole trip to the World without a stroller at any point along the way, I don't need to bring a roller. And I have figured out how to get all her stuff into her carry-on-able small world duffle. And how to get all of my stuff into the Osprey bags. But it took me _days_ to puzzle out why I hadn't done it sooner, because I'd forgotten all the constraints.

The brain works in mysterious ways. If you're ever trying to figure out why someone did what they did, just remember me. It can take me a really long time to figure out why _I_ did what I did. And I was there.
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OK, so, some people are clearly not grabbing a clue from the title. YES, the book is loaded, larded, completely laden with f bombs. If that is a problem for you, this is not a book for you. Don't read this book if you aren't loving the f bombs. Seriously.

Sarah Knight has written an effective parody AND an effective self-help book. The topic of the self-help aspect is prioritization of time/energy/money in line with one's values. Most of the book is devoted to introspection on what aligns with your values and figuring out how to say no to things that don't align with your values but do exhaust your time/energy/money, without being an Asshole (TM). She explores some of the domain of being polite vs. being honest while saying no.

The books weaknesses require little contemplation to identify. Her evaluation function is too present-focused. It is only at the end of the book that she makes any effort to help the reader figure out what they should be doing now so that they don't wind up regretting not doing it later. A lot of duty/obligation stuff is devoted to getting you to avoid this situation, and since she is jettisoning duty/obligation, I think she should have spent more time on this.

But you know? It's her book. And it is fairly humorous.

It's hard to know if this would _help_ any particular reader. I don't know that I was helped by it (but I was vastly entertained, and a little disturbed by how many of the examples it wouldn't even occur to me to feel any guilt about). But if you feel like you are being nibbled to death by small requests difficult to say no to, but which are not advancing you along your spiritual path, hey, can it really hurt? There are at least several giggled in it.
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I bought this in paperback at Willow Books for 40% off because it was on the clearance shelves in the foyer. I have no idea why this was on the clearance shelves. It's a good book and please don't take insult if I send you a copy in the next few days. I mean well, and I might actually intend for you to read it and think about whether someone closely connected to you might benefit from it.

I was at Willow Books to buy a gift certificate for my walking partner. While I was there, I bought a couple other books, too. Hopefully I'll get around to reading and passing along those books as quickly as this one, but honestly, I don't have a great track record with paper books in a TBR pile; it is one of the reasons I switched so hard over to reading on the kindle. Also, my eyes.

In any event, _The Worry Trick_ is a self-help book. If you read it without having the problem in question, because, like me, you are trying to understand what is going on in someone else's head, then you, like me, will likely stumble over the many moments where Carbonell says, Pick a Persistent Worry You Have. Or, You Wouldn't Be Reading This Book Unless. But that's okay; I hope those passages and exercises work well for the intended audience. They certainly look and sound plausible. Many times, Carbonell says something along the lines of, the intuitive response to blah blah blah is to blah blah blah, and I go, what? That's not why I do in that situation, it wouldn't work. What he suggests next is often on the list of things I _would_ do in that situation, which gives me confidence that his tactics are aligned with my values.

Here is the meat of the book. Carbonell comes at chronic worry from an acceptance and commitment framework. This is within the overall umbrella of cognitive behavior therapy, but differs from other CBT approaches to chronic worry. He specifically describes cognitive restructuring as a CBT tactic that does help many people but often does not help the people this book is aimed at. His basic theory is that people suffering from chronic worry have misidentified nervousness and uncertainty as danger. He states that they tend to have one of two stances with respect to worry: a desire for absolute certainty that the thing they are worried about will not (ever) happen and/or a desire to never have thoughts that the thing they are worried about might (ever) happen.

I think most of my readers (but not all) will take a look at these two stances and then have to pause for a moment to retrieve their eyeballs (because they popped right out of their heads!) or their jaw (from the floor where it fell). If I'd actually understood the desire for absolute certainty, I would have addressed that over the content of the worry. If I had understood that the goal was to never have a thought that something bad might happen ever again, I would have addressed that as an unattainable goal. Instead, I tend to do what amounts to cognitive restructuring, with a bit of reframing thrown in for good measure, along with a solid chunk of, hey, if that happened, here's what I think you would probably do to cope with it so you can rest assured that you will appropriately respond should it happen to pass, possibly with a dollop of, if you took this small action now, it would further reduce the small likelihood of this bad thing happening/this thing happening and causing problems for you down the line. That does feel really good, but it doesn't _stick_, because the stance is ABSOLUTE CERTAINTY or TOTAL LACK OF AWFUL THOUGHTS, neither of which is possible (or, I would argue, desirable).

The balance of the book is a combination of, here's what the inside of your head is like, broken down in very small steps so you can see how it works mechanically and here's a set of interventions to help you tolerate the bad thoughts, and reduce your desire for absolute certainty/total absence of what-if-bad-thing thoughts. Basically, some paradoxical strategies, some humor, some singing, and some prescribe the symptom stuff.

This is not a book for all kinds of anxiety. If your anxiety is reprocessing of past events, it probably will be of limited utility. The basic problem this book solves for is: improving strategies for coping with what-if-something-bad thoughts.

One final word. Everyone (wow, I sure hope, anyway) has thoughts that are formed more or less as: what if something bad. This book doesn't get rid of those thoughts. This book does not help you prove that the something bad can't happen. This book gets you to the point where you go, hunh, that's an interesting thought. It gets you to the point where if, as a result of a stressful period in your life, those thoughts are happening at a high rate, you can still take care of yourself even while the what if something bad thoughts are still parading through your increasingly exhausted brain. Please believe me when I say, getting to that point is a wicked awesome place.
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Another library selection. I was looking for a book about narcissism, because a friend of mine has had problems with narcissists, then there is the obvious election thing. The book I found in the library was unsatisfying, so I thought I would pick up a book about personality disorders in general, since I have not too long ago had a strong interest in better understanding Borderline Personality Disorder and found learning more about it to be really rewarding in terms of better understanding, better ideas for how to be around people with this particular issue without making things worse (and possibly helping to support them emotionally), and in general feel more compassion.

During the lead up to the DSM V, there was talk that perhaps personality disorders would be reworked entirely, to be one true personality disorder list of criteria, and then a more detailed coding/listing of how it manifests. Dobbert's book was written before that debate occurred. In the event, the new approach is listed as an alternative. I was hoping that reading Dobbert might give me a sense of what is shared across personality disorders. Instead I wound up coming to a very different set of ideas.

I really liked this book, and I think it is generally very useful. The author is not mean spirited, nor does he engage in obvious name calling (you might go, well, duh, but you might read some books about personality disorder to get a sense of how rampant that is before you conclude that this bar is too low). He intends his book for a general audience; he himself comes from a forensic/criminal justice background, which shows up a lot in his discussion of antisocial personality disorder, and his inclination to think that conduct disorder should be rolled in to the personality disorders (I don't disagree with him). I particularly liked the section on Histrionic Personality Disorder, because I had no idea what that was (I'd heard of it, but didn't have any sense of it); once I read through it and told a friend, she immediately said, I know someone like that!

And that's perhaps the best thing about this. It is like a bird spotting guide or a nature book that you can take on a hike, only it is for people who make us all scratch our head and go, what the heck is that all about anyway? We can't figure out where the win is, they cause all kinds of problems in groups, are difficult to work around and sometime force us to quit participating in organizations or change jobs just to get away from them. Well, if you've ever wondered what was going on, maybe you'll find the same sort of value in this book that I did.

The set of ideas I came to after reading this was as follows. I knew that some of the schizo* personality disorders were confusing and difficult to tell apart (I don't have that problem any more!), and I had reason to believe (mostly because of reading people's posts on Wrong Planet) that they were either "cousins" of autism spectrum, or autism spectrum in its higher functioning forms compounded with other problems. Here's my first cut at that:

schizoid personality disorder = mainstreamed, HFA person with depression, who has not yet/ever found people of like minds. I think if you treated the depression, and then helped them Find Their People, they would wind up just looking like other autism spectrum people. Pretty varied, still gonna need a lot of alone time, and still reduced affect, but not NO affect. Might also have an asexual component; wouldn't know for sure until the depression was addressed and Their People were found

schizotypal personality disorder = HFA person, possibly from a spectrum family, weird ideas. Might think they are psychic. Might have a lot of odd ideas about UFOs, occult, etc. The spectrum component means they don't have any perspective taking ability so they don't realize that they shouldn't talk about this stuff around mundanes. Work on the perspective taking issues, walk them back from any paranoia they have developed, get them into a social skills program. Once they "get" that they need to be a little selective, and if you can help them find some flavor of Their People which isn't too terrifying, further descent into paranoia and delusions will probably halt/reverse.

obsessive compulsive personality disorder. Best BEST thing about this book: I can now actually keep track of the difference between OCD and OCPD. Never thought that would happen! I have some issues with his description of OCPD, in that his scenario has someone who weight cycles, which just makes very little sense to me. My sense is that OCPD tends to be more associated with anorexia type eating disorders than bulimic type eating disorders. But who knows. People are exploring the possibility that OCPD has autism spectrum components, but there is a tremendous amount of resistance, because if it turns out that is true, then a lot of the received wisdom in eating disorders, hoarding, etc. is going to turn out to have been entirely wrong headed. Also, it may turn out to be the case that there is a fraction of OCPD which is autism or autism like, but another chunk which has a very different etiology.

Don't blame Dobbert for any of that rambling mess! He's a very reasonable person and I am engaging in early stage, uninformed speculation. But his book is concise, clear, well cited and easy to read. It'll help you understand confusing people, I can almost guarantee it. At the end, he has a neat appendix of various psychologists/psychoanalysts/etc. contribution to the ideas in the book; it was there that I learned about (possibly again) Karen Horney, who I am going to try to read some of because I think a lot of her ideas about how people deal with (or don't) fears and anxieties might be quite fruitful to contemplate.
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This was NOT a library book; I read it on the kindle.

I had been looking for a book about NPD that would be sort of like what _The Buddha and the Borderline_ was for BPD: written by someone who was a bit of an activist, who had/has the diagnosis, and was a lively storyteller. This is NOT that book; I don't know if such a book exists, but if you know of one please tell me!

In the meantime, Malkin's book is the best I've found on the topic. Unlike the other book I read which mashed up narcissism as a character trait and NPD as something diagnosable, Malkin has an orderly way of thinking about the range, and a convenient little quiz to help the reader figure out where she is on that range. He argues exactly what I argue: the upward drift in scores on the standard inventory for narcissism is measuring increased self-esteem, which is not the real problem in NPD. But he goes much, much further.

He divides narcissism into three components: Thinking You Really Don't Deserve Anything-osis (not his term, or Doc McStuffin's term), Healthy Narcissism (the trait which enables us to dream big dreams and pursue them, and which helps us acknowledge our wants/needs/desires enough to make sure they are satisfied), and Toxic Narcissism (I'm Better Than Everyone Else, especially when abused to make oneself feel better). Those who score high in the first section he says suffer from Echoism. The goal is to score about right in the middle, and not too high on either end. The third component is a problem when rather than comforting ourselves by connecting with those we love and similar, we instead refer inwardly, reinforcing a belief that I Am Better Than Anyone Else. As that moves from habit (a problem, but correctable) to addiction (much harder to recover from), it erodes empathy and drastically interferes with problem solving and other necessary life skills.

He even notes that people can score high on both extremes (wow, does that explain some people!), and describes them _very_ recognizably.

Malkin isn't just here to help us spot troublemakers and avoid them (he does do that, too!). He is also here to help us move to the sweet spot in the middle, and adjust how we interact with others to help _them_ move to the sweet spot in the middle. There is some really pragmatic, useful advice on how to assess toxic coworkers (friends, family members) and figure out to what degree we can adjust them down to the middle -- or limit our contact. His section on what causes narcissism in terms of child rearing is a little above average, altho not awesome (it's the usual authoritarian/permissive/authoritative analysis and advice; it's like P.E.T. hasn't been around for decades with an alternative approach. You know, if people _acknowledged_ the P.E.T. approach and said, here's why it sucks, I'd read that in a hot minute. But people pretend it doesn't even exist. It is Weird.). I cannot tell you how happy I was to see Twenge come in for some much needed criticism.

I also got a lot out of things like the description of "twinning" in narcissistic friendships. It fits very well with the theoretical framework of Love Maps, altho Malkin doesn't mention them (or I failed to notice if he did). And it helped explain on a mechanical level why people who think you are their soul mate/Just Like Them on very little knowledge of you are So Problematic To Be Around.

Malkin is a pretty chatty writer. His section on Social Media was somewhat irritating to me (SoMe? Really? Well, then what did the We in SoWe stand for), but I didn't actually disagree with his analysis or conclusions. I just eyerolled my way through Another Newbie the way I have been doing for decades, which probably just means I am a shitty human being.

Whether you believe that NPD is a real thing, or have never heard of it, or are somewhere on the fence (as I have been recently), Malkin's analysis of narcissism as a character trait that can become toxic at the extremes is a WONDERFUL frame for thinking about how we do -- and how we could instead -- think about and feel about ourselves. It is particularly wonderful that he draws a direct line between thinking well of ourselves and being able to Dream Big and then actually implement. There is so much messaging -- especially towards women -- that kills Big Dreams that are pretty attainable. I'm not talking about discouraging a kid from wanting to be a fire fighter or ballerina or a rock star or whatever. I'm talking about the way we destroy entrepreneurship, and we assume that there is no point in pursuing aesthetic pursuits if we aren't going to be The Best Ever in The World. Aesthetic pursuits are gifts that support joy throughout one's life. It's worth it to have at least one you love, whether it is drawing, sculpting, making music, dancing or something else. At a minimum, we should all have some aesthetic that we consume; participation is better. We need to do a better job at helping people -- young and old -- translate participation in the arts into something that they can find meaning and pleasure in OUTSIDE of career/job. And we need to do a MUCH better job at supporting practical entrepreneurship, whether that means founding your own enterprise, or learning how to direct and develop your own career or taking the initiative to suggest new projects within an existing institution. (And everything I just said can be applied equally well to athletic pursuits, where we all to often act like people who can't Make the Team somehow shouldn't participate in Sport or physical activity in any form at all.)
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Another library pick. I wound up skimming. I was not particularly impressed. Kluger is simultaneously talking about many different ways of thinking about narcissism (from having higher self esteem than he thinks you should have to taking more selfies than he thinks you should to something more recognizable as NPD in the DSM), which makes it sort of hard to pin down why his approach is so irritating. Narcissism as a character trait in the extremely loose and changeable way he treats it doesn't strike me as anything negative at all -- many, many, many therapies and activists have been arguing that we must love ourselves before we can meaningfully love anyone else, after all. And women as a group aren't helped by continuing to downplay their capacities and achievements.

Also, he apparently wrote the Apollo 13 book a while back, and he really wanted to make sure the reader knows all about that, which made me think things like, who is the narcissist here and projection.

I'll keep looking for a better book about NPD. This isn't what I was hoping for, which I would loosely characterize as _The Buddha and the Borderline_, but for NPD. I want something written by a person who identifies as having (had) the problem, who has an activist bent, and who is right up to date on the clinical approaches to treatment, possible outcomes, etc. I know, I know. So demanding!
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I really think that a lot of our approach to identifying people who need support would work better if we focused on smaller-than-diagnostic modules (such as social interaction problems), rather than characteristic clusters (like ADHD or ODD or ASD or whatever). This particular analysis seems to share that way of thinking about kids who need support.

I've been really wondering a lot about the overlap between ASD and ODD for years now, especially as we have tried to have playdates with kids with the same diagnosis as my kids, but a very different range of symptoms. I had convos back when A. was doing EI with therapists who said that some parents diagnosis shop, which I just wasn't sure whether I really believed that was a full explanation or not (really, are all these high energy, high conflict kids with ASD diagnoses actually ODD instead? Because they sure set off my ASD-dar for the rest of the package: social interaction issues, sensory problems, narrow areas of deep interest, etc.). I try not to blame parents (because I don't want to be blamed, either!), and I sure recognize that when a parent has needs that aren't met, that is going to limit how much the parent can then do for their child. Part of why we work with a play therapist is because I recognize my limitations at helping kids solve relationship problems in a play context without either creating high structure or making the situation worse in some other way (neither of which gets at the thing I want my kids to be better at than I am, which is being able to relate well to other people and share goals and cooperate and All That Good, Prosocial Stuff).

I'm starting to think that maybe ODD actually starts out as what I think of as Grumpy Old Man Syndrome. You say, hey, let's do X. GOM says, NO! If you wait a few minutes, GOM will say, hey, I have an idea. Let's do X! Annoying as fuck, but manageable, if you can avoid engaging with the initial no. If you make the mistake of trying to convince GOM to do X, GOM will escalate and entrench, until GOM is saying that X will kill the kiddies, give us all cancer and directly start Armageddon within his limited remaining lifetime. Also, cost too much money. A parent that doesn't have GOM, and who figures out early on to wait, and maybe do some environmental nudging towards X, and doesn't require the GOM to admit it was actually the parent's idea, etc. etc. etc. can take a kid with GOM and produce an adult who may be a little annoying at times (especially when tired or surprised out of their routine), but is basically functional. A parent who has severe GOM themselves may wind up making an adult with severe GOM, aka, ODD. Assuming they don't just kill each other when the kid hits puberty.

We tend to think, oh, let's fix the kids and then it'll be good in the next generation. And I'm like, yeah, that's probably never going to be good enough for things like really entrenched, multi-generational GOM. You are going to have to mitigate with the 'rents, if those kids are gonna have any chance at all.
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It's a great article, in part because it is so respectful of why we categorize things the way we do, and why that is a communication problem generally. This isn't someone saying WRONG WRONG WRONG must fix. This is someone saying, Okay, you can think of it one way or another way. I think this way of thinking about it is a lot more helpful, and here's why.

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In this case, I refer to this:


I was looking at books by Linehan or where she was listed as an editor/co-author. Several comments referred to ACT, and I went, what the heck is that? Basically, if you take the Milton Erickson -> Bandler and Grinder -> wtfery, rip out Erickson's Let's Make Everyone a Member of a Heteronormative Family and, instead of leaving a total absence of values, insert a sort of Buddhist thing, you'd get ACT. Language oriented observation that a lot of people are busy avoiding/suppressing/trying to destroy their internal convo and that has bad effects. Their internal convo is quite painful, and they need help tolerating it. Unlike other CBT approaches, there is no assumption of underlying health, nor is there a goal of "control".

Seems pretty amazing. I am very excited to learn more! Anyone run across anyone involved in this as a clinician, patient, family member or friend assisted by the approach, etc.?
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For people unfamiliar with the concept of refactoring, this is the one I'm thinking of:


"Refactoring is usually motivated by noticing a code smell.[2] For example the method at hand may be very long, or it may be a near duplicate of another nearby method. Once recognized, such problems can be addressed by refactoring the source code, or transforming it into a new form that behaves the same as before but that no longer "smells". For a long routine, one or more smaller subroutines can be extracted; or for duplicate routines, the duplication can be removed and replaced with one shared function. Failure to perform refactoring can result in accumulating technical debt; on the other hand, refactoring is one of the primary means of repaying technical debt."

The basic idea is simple. If a body of code contains basically the same functionality in more than one location, it is harder to maintain. If the same functionality must be changed, the change must be made in all the locations, rather than just one. Also, more code means more to remember and understand.

In the course of reading _Neurotribes_, I learned that one of the original perpetrators of the DSM, Adolf Meyer, wasn't really interested in resolving the disputes between then-extant forms of psychoanalysis, and thus the DSM was a sort of catholic (with a small c) document intending to capture multiple ways of thinking about a disorder, a handbook usable by all practitioners using one of the common modes of analysis.

Obviously, Meyer's approach helped validate and apply a first cut of consistency to diagnosis in a nascent field. However, Meyer's approach _also_ lent itself to an octopus-like field of competing theories of the same presenting cluster of symptoms, usually the result of focusing on different aspects of the Problem: is the presentation thought of from a relationship perspective, an individual perspective, a member of a family perspective, is it thought of as having a biological component, as a result of a developmental process, as an adaptation, etc.

Basically, this fucker is _ripe_ for refactoring.

I tend to dislike psychological diagnoses in general, because I think they are creaky, large and pointless structures that do not suggest a solution that a Real Life Person or their compadres in life might view as Helpful. In the interests of coming up with a small, identifiable and measurable Thing that can be adjusted, I think of our psychological makeup as being an assemblage of modules. But while I really want to get into that, I'm not going to do that right now, because I Noticed Something Interesting. See, I _want_ to refactor the whole DSM to reflect my theory of modules, mostly for my own personal interest and to get it all neatly organized in my brain.

Right at the moment, however, I cannot help but notice a startling similarity between Somatoform Disorder and Borderline Personality Disorder. You may know the former as Munchausen's, and you may be more familiar with the much more Outrage Inducing Newsworthy cases of Munchausen's Syndrome by Proxy, in which someone gets lots of attention by making it look like their kid has a whole lot of stuff needing medical attention but it is all a big ole fake.

Backing up a ways, Somatoform is where all that psychological paralysis and psychological hearing loss, and a host of other things that showed up on "House" over the years wound up in a bin together: you _look_ like you have some Serious Thing and you're really freaked out about it, and you probably really _do_ feel those feelings (like thinking you are pregnant when you aren't), and for most purposes those seizures are real they just persistently refuse to show up on an EEG -- generally there's no medical evidence for what you have and this kind of thing has been happening on and off since before you were 30. Somatoform is difficult to treat.

The refactor I'm proposing is: Borderline Personality Disorder is Somatoform disorder, only it is focused on the medical health profession, specifically.

Now, before you go, like you know anything about any of this, check this out:


I am not the first person to think of this. (Conversion disorder is a subset of somatoform and DBT is the only evidence based treatment for BPD.)

Before that, on page 99 of: The Mind-Body Interface in Somatization: When Symptom Becomes Disease, by Lynn W. Smith, Patrick W. Conway, the authors note that there's a lot of personality disorder comorbidity with somatoform disorders, they share some developmental factors (history of physical and sexual abuse, presumably, but probably also chronically critical and hostile childhood environment and a lack of a safe caretaking relationship), and people with somatoform disorders have the same ego deficits (unstable and/or fragmented sense of self, identity subject to radical, rapid changes) that are targeted by the skill building of DBT. When that book was published (2009), they couldn't find anyone trying this, but they think it's worth a shot.

July 2017

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